June 2, 2021

new report from the International Women’s Health Coalition (IWHC) shows that the harmful impacts of the Trump administration’s Global Gag Rule persisted and deepened as the policy moved into the third year of implementation.  While the Global Gag Rule was recently reversed by executive action under President Biden, IWHC’s research shows that the policy has long-term impacts, even when it is not in place. Without legislative action from the US Congress to permanently end the policy, the Global Gag Rule remains a serious threat to women’s health globally.  

“The research is clear that the Global Gag Rule is a deadly policy and will have far-reaching implications on global health care for years to come,” said IWHC Advocacy and Policy Director Shannon Kowalski. “The Trump administration is gone but the harm from this policy continues to impact access to health care, particularly for the most marginalized women and girls around the world. And the threat of future harm is still very much a concern.”   

The Global Gag Rule, first enacted by President Ronald Regan and drastically expanded by President Trump, prohibits foreign nongovernmental organizations (NGOs) that receive US global health funding from providing abortion services, counseling, referrals, or advocacy—or funding other organizations that do so—even if they use their own funds. The policy forces NGOs to make the difficult choice between offering honest and comprehensive sexual and reproductive health care or receiving critical US funding. In January 2021, President Biden officially rescinded the policy but further action from US Congress is needed to prevent future US presidents from reinstating and expanding the policy in future years.  

Since implementation began in 2017, IWHC and grantee partners in Kenya, Nepal, Nigeria, and South Africa have conducted more than 260 interviews with individuals affected by the policy. The interviews reveal that the Global Gag Rule reduced the quality and availability of care, particularly for marginalized communities. In all four countries, the policy cut off access to both comprehensive sexual and reproductive health information and services. Reduced access to contraceptives and abortion care leads to unwanted pregnancies, unsafe abortions, and preventable deaths. 

Evidence shows that the policy impacts the integration of health services beyond sexual and reproductive care, including community health centers where patients receive a variety of services including malaria treatment, HIV/AIDS care, and more—dismantling a decade of US investments to integrate health care services and strengthen health systems. 

The Global Gag Rule further stigmatized and silenced the voices of organizations that work on abortion, and emboldened anti-abortion ideologues in all four countries. Documentation in Kenya and South Africa shows that there has been an increase in activity by organizations that provide abstinence-only education and hold extreme anti-rights views. This has shifted policy conversations from a focus on human rights and bodily autonomy to one on religious values and subjective morality. One NGO director in Kenya noted that, under the Global Gag Rule, “the anti-choice movement is thriving.” 

“We are encouraged by the Biden administration’s action so far to remove this policy,” said Kowalski. “Now, it is time for US policymakers to pass the Global HER Act and end the Global Gag Rule for good. Women’s health and lives are at stake.” 

IWHC’s recommendations to mitigate the ongoing impact of the Global Gag Rule include: 

  • The US Congress should permanently end the Global Gag Rule through passage of the Global HER Act. 
  • The US Congress should repeal other abortion restrictions in US law including the Helms Amendment and similar restrictions on the use of US foreign assistance funds. 
  • Donor governments and organizations should seek to close the funding gap by increasing funding to groups affected by the Global Gag Rule, while prioritizing local and community-based organizations. 


The report is the third in a multi-year study conducted by IWHC and its grantee partners. Since 2017, IWHC along with partners in Kenya, Nepal, Nigeria, and South Africa, conducted more than 260 interviews with civil society organizations, health service providers, anti-abortion groups, and government agencies across the four countries. IWHC’s partner organizations are: Trust for Indigenous Culture and Health (Kenya), Center for Research on Environmental Health and Population Activities (Nepal), Education as a Vaccine (Nigeria), and the Critical Studies in Sexuality and Reproduction Unit at Rhodes University (South Africa).  

Full Report: Click here to download Care Denied: Year Three Impact of Trump’s Global Gag Rule. 

Video Asset: View the video to hear directly from advocates and researchers from Kenya, Nepal, Nigeria, South Africa, and the United States detail the harms of the Global Gag Rule on their communities. 

Featured photo © Thomas Cristofoletti / USAID